Excimer laser treatment combined with riboflavin ultraviolet-A (UVA) collagen crosslinking (CXL) in keratoconus: a literature review.

PURPOSE: To review the clinical outcome of keratoconus patients after excimer laser treatment with combined riboflavin UV-A collagen crosslinking (CXL) treatment was reviewed in light of the UDVA, CDVA and HOA. METHODS: Following a PubMed-based literature review of studies on excimer laser treatment with combined riboflavin UV-A CXL published between 2009 and 2018, peer-reviewed English-written studies were evaluated using the GRADE approach ( www.gradeworkinggroup.org ). The current review focused on the change in the (un)corrected distance visual acuity (UDVA; CDVA) and higher-order aberrations (HOA) as well as the prevalence of postoperative complications. RESULTS: Five studies with a total of 573 eyes were included, thereby reporting on 479 eyes were treated with the aforementioned combination therapy. The control group consisted of 94 eyes in total. Changes between pre- and postoperative CDVA and/or UDVA were statistically significant in all five studies after at least a 24-month follow-up period for the combined excimer laser-assisted CXL treatment in comparison with the CXL-only treatment option. Three studies described statistically significant reduction in the number of total HOA, in particular, those related to coma and spherical aberration. Corneal haze was reported in four studies, but the condition was successfully treated in all cases. CONCLUSION: Current studies suggest that CDVA, UDVA and HOA in low-to-moderate keratoconic patients improved in a combined treatment without sacrificing biomechanical stability of the cornea. However, long-term results are needed, as the studies in our review have a follow-up period of 68 months or less.

[The Limits of Selective Laser Trabeculoplasty in Glaucoma Therapy]. / Die Grenzen der selektiven Lasertrabekuloplastik zur Behandlung des Glaukoms.

Introduction: The aim of this study was to evaluate the efficacy of selective laser trabeculoplasty (SLT) in the University Eye Hospital Hamburg Eppendorf. Material and Methods: We conducted a retrospective analysis of 113 eyes of 113 consecutively treated patients who underwent SLT treatment between 03/2011 and 01/2014 and had a follow-up of at least 4 months. Results: Intraocular pressure was reduced by 1.08 mmHg (7 % reduction) on average. In 43.7 % of the treated eyes, additional medical or surgical glaucoma treatment was necessary within 12 months. Conclusion: SLT is not effective as monotherapy in pre-treated eyes with low target pressure.

[Central arterial occlusion after blunt force ocular injury : Case report]. / Zentralarterienverschluss nach stumpfem Bulbustrauma : Eine Fallvorstellung.

A healthy young male patient suffered a nearly complete loss of vision after a minor ocular injury. We describe a rare case of central arterial occlusion after blunt force trauma. After rheological therapy the visual acuity increased from perception of hand movement to 1/20, 1 month after the injury. Central artery occlusion is a rare but severe complication after blunt force ocular trauma that should be considered when patients suffer severe posttraumatic loss of vision.

[Psoriasis-associated keratitis: case report]. / Psoriasisassoziierte Keratitis : Eine Fallvorstellung.

Psoriasis is a common skin disease, which is associated with multiple extracutaneous manifestations. This article presents a case report of a rare ocular manifestation of psoriasis; psoriasis-associated keratitis. In a 37-year-old man we could show that systemic immunomodulatory therapy led to a rapid improvement of the ocular symptoms.

Superiority of Nd:YAG laser to cryosurgery in the treatment of rectal carcinoma.

Laser coagulation (LC) by Nd:YAG laser and cryodestruction (CD) by insulated cryoprobe were done in 52 patients with carcinoma of the rectum (LC = 27, CD = 25). The patients were divided into four groups: group I, inoperable rectal carcinoma because of advanced stage of malignancy, severe concomitant disease, old age (LC = 14, CD = 12); group II, patient refused permanent colostomy (LC = 4, CD = 3); group III, polypoid lesion fulfilled the criteria of local excision (LC = 3, CD = 2); group IV, local recurrence after anterior resection (LC = 6, DC = 8). The mean hospital stay was 8.11 +/- 5.6 days for LC and 12.8 +/- 8.7 days for CD (p less than 0.05). For LC minimal or no sedation was needed, but for CD general anesthesia (n = 3) was occasionally necessary. Significant improvement was achieved in 85.18% (n = 23) of cases with LC and 56% (n = 14) of cases with CD (p less than 0.05). Complications after LC were mild (n = 7) to moderate (n = 3) and after CD they were moderate (n = 11) to severe (n = 2). Almost every patient with CD complained of moderate to severe discharge of malodorous necrotic tissue for a period of 2 weeks or more. In groups I, II, and IV patients with LC enjoyed a longer (81.08 +/- 47.48 days) trouble-free period than those with CD (43.3 +/- 13.45 days) (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hiatal hernia and its endoscopic diagnosis]. / Khiatusna kherniia i endoskopskata i diagnostika.

In 161 patients with endoscopically proved axial hiatus hernia the relations between the size of the herniated segment, its fixation and the inflammatory processes in the distal oesophageal segment were studied. The fibroscopically easily determined widely open cardia demands the performance of inversion cardioscopy and reontgenologic precision of the His angle which are necessary for the diagnosis of the vestibular and cardiac hiatus hernia.

[Use of selective nutrient media for isolating the streptococci that cause mastitis]. / Prilozhenie na niakoi selektivni khranitelni sredi za izolirane na streptokoki, prichiniavashti mastit.

Studied was the diagnostic value of the liquid enriched nutrient medium - Streptococcus broth with kanamycin, used for the isolation of Sc. agalactiae and other mastitis streptococci in individual milk samples as well as that of blood dextrose agar with polymyxin + Staphylococcus toxin seeded after Koch for the isolation of Sc. agalactiae and other hemolytic streptococci in pooled cow milk. Direct seedings in thallium sulfate-crystal violet-B toxin blood agar (TKT agar) were used as a control. It was found that the enriched Streptococcus broth with kanamycin yields growth of 0.23 per cent more Sc. agalactiae organisms and 1.82 per cent other mastitis streptococci in individual milk samples as compared to the TKT agar. The blood dextrose agar with polymyxin seeded after Koch demonstrates fivefold more Sc. agalactiae in pooled cow milk as against the direct seedings in TKT agar, and it can be used to confirm the infection on the farms.

[Differentiation of the streptococci isolated from the milk of cows with mastitis]. / Diferentsirane na streptokoki, izolirani ot mliako pri mastit po kravite.

Differentiation was carried out of a total of 170 strains of streptococci that caused mastitis, which were isolated from 3200 milk samples taken from a farm. Ouchterlony's agar gel precipitation method was employed for the serologic typing of the strains along with the Jonagar No. 2 Oxoid and group antisera. The biochemical behaviour of the strains was followed up with regard to the hydrolysis of esculin and sodium hippurate, the fermentation of lactose, sucrose, glucose, trehalose, mannite, and salicin, and the breakdown of arginine. It was found that 17.05 per cent of the isolated mastitis streptococci belonged to group B, 17.64 per cent belonged to group C, and 62.94 per cent--to group C. Untypeable were as many as 2.37 per cent. The behaviour of these three groups of mastitis causative agents with regard to esculin and sodium hippurate proved most stable in the biochemical differentiation of the strains. In this respect the selective TKT agar medium could be used in a mass scale diagnosis for the rapid differentiation of the most frequently isolated mastitis streptococci on the base of the characteristic morphologic traits.

[Indirect methods of determining the amount of cellular elements in bulk cow's milk]. / Prouchvaniia vurkhu indirektni metodi za opredeliane kolichestvoto na kletuchnite elementi v sbornoto krave mliako.

Comparative studies have been carried out to establish the practical value of three indirect methods--Whiteside, Bernburg, and the antiformin one--intended for the rapid determination of the somatic cell count in pooled cow milk. A total of 556 samples of milk from various sources have been studied. The data obtained with the use of the direct method of Prescott and Breed served as control values of the cell elements in milk. A conclusion has been made that the test after Whiteside is the most appropriate one for the rapid determination of the cell count in pooled cow milk: it gives positive results in 100 per cent of the investigated samples having a count of more than 500000 cells. The use of this method is suggested in the case of detecting farms where mastitis is a problem.

[Cellular element study of bulk milk]. / Prouchvane vurkhu kletuchnite elementi na sbornoto mliako.

Cytologic and microbiological investigations were carried out of pooled milk arriving in two milk plants, coming from various farms in amounts of 300 to 4 000 1. Additional studies were made of milk samples taken in the barn after milking a group of 15--30 cows in amounts of 80--260 1 and samples from tanks with capacity of 6 to 10 tons stored in the milk plants. Cell content was indirectly determined by rapid mastitis tests and directly by Breed's method; cultures were made on TCT medium to establish mastitis Streprococci and most of all of Str. agalactiae. It was found that the cell content of pooled milk arriving in the milk plants is in 80.74 per cent under 400 000 and in 19.26 per cent over 400 000 cells per cc milk. Their determination in pooled milk is a reliable orientation index for evaluation of the farm's mastitis status. A norm is suggested for the cell content of pooled milk--400 000 in cc milk--which corresponds to the present yeild conditions and to those in the near future and to the real possibilities of occurence of secretion disturbances and bovine mastitis. The adoption of the norm will improve mastitis control and will raise milk quality.

[Occurrence and etiology for subclinical mastitis in cows]. / Vurkhu razprostranenieto i etiologiiata na subklinichnite mastiti po kravite.

Studied were a total of 16,571 cows on 89 farms by means of the Bernburg test. Milk was sampled from the positively reacting quarters of the udder by taking 18,047 samples intended for bacteriologic investigation. The demonstration of mastitis streptococci was carried out on "TKT" agar Merk, of pathogenic staphylococci, hemolytic streptococci, and Corinebacteria--on dextrose agar Oxoid containing 7.5% citrated calf blood. The isolated hemolytic streptococcus bacteria from the two nutrient media were differentiated through the CAMP test as well as serologically by the precipitation agar gel and Difco sera. The pathogenicity of Staphylococcus bacteria, in addition through hemolysis, was tested by the use of plasma coagulase with citrated rabbit plasma. In 53.95% of the cases there were secretory lesions due to Sc. agalactiae (6.23%) to Sc. dysgalactiae (5.69%) to Sc. uberis (8.47%), to Staph. aureus (2.44%), to hemolytic streptococci of the C, G and L groups (0.28%), to Sc. viridans (0.03%), to Corynebacterium pyogenes (0.41%), and catarrhal mastitis (30.4%). Some of the causative agents, such as Sc. agalactiae, Staph. aureus, and others have proved of epidemiologic importance to humans.

[Hibitan and Iosan SST in the prevention of subclinical mastitis in cows]. / Khibitan i iozan SST v profilaktikata na subklinichnite mastiti po kravite.

The effect was tested of the disinfection preparations hibitan and iozan SST under field conditions in the course of six months. The animals treated were included in two groups: group I--with 20 cows, and group II--with 39 cows. All animals were free of mastitis-causing agents. The udder of the animals in the first was disinfected with hibitan-super-concentrate (7.5 per cent chlorhexidin gluconate). Prior to milking the udder was washed with a 0.12 per cent solution. After milking the teats were disinfected with a hibitan cream. The udder of the animals of the second group was disinfected with iozan SST (17.6 per cent tensit-iodo-iodide complex). Prior to milking the udder was washed a 0.5 per cent solution, and the teats after milking were disinfected with a 33 per cent iozan SST solution. It was found that the washing of the udder and teats as indicated above in the course of 6 months rules out the outbreak of the infectious subclinical mastitits in cows. It is suggested to adopt the use of the two preparations to prevent mastitis in field and farm practice.